ED Coding and Reimbursement Alert

Question: I have been running into problems with code 99058. Could you please tell me when am I able to use this code?

Marie Nikolaidis
Porter, Texas

Answer: You can use code 99058 (office services provided on an emergency basis) if the physician was called in to the office after hours or on a weekend to see a patient for emergent care.

The problem with this code is that Medicare does not pay for it under any circumstances. Most of the HMO, PPO, and other managed-care companies follow Medicares lead and deny it as well. I have checked several fee schedules and have not found this code listed on any of them, and as far as I can tell, there are no RVUs assigned to the code, says Andrea Lamb, CPC, a coder for St. Joseph Medical Center, a multi-specialty practice in Buckhannon, W.Va.

Some commercial carriers may pay for 99058, but I would hesitate to bill it. Instead, consider billing a higher level of evaluation and management, making sure that the physician documentation supports the code selected. Documentation of the examination, risk factors and medical decision-making should support a higher level of E/M in a true emergency. Also, it would be wise to document the time spent with the patient as a back up in case the carrier requests a review of the medical record. This code would not be used for coding an emergency department visit.